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Rincon Sabatino S, Rivero A, Sangaletti R, Dietrich WD, Hoffer ME, King CS, Rajguru SM. Targeted therapeutic hypothermia protects against noise induced hearing loss. Front Neurosci 2024; 17:1296458. [PMID: 38292902 PMCID: PMC10826421 DOI: 10.3389/fnins.2023.1296458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/14/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Exposure to occupational or recreational loud noise activates multiple biological regulatory circuits and damages the cochlea, causing permanent changes in hearing sensitivity. Currently, no effective clinical therapy is available for the treatment or mitigation of noise-induced hearing loss (NIHL). Here, we describe an application of localized and non-invasive therapeutic hypothermia and targeted temperature management of the inner ear to prevent NIHL. Methods We developed a custom-designed cooling neck collar to reduce the temperature of the inner ear by 3-4°C post-injury to deliver mild therapeutic hypothermia. Results This localized and non-invasive therapeutic hypothermia successfully mitigated NIHL in rats. Our results show that mild hypothermia can be applied quickly and safely to the inner ear following noise exposure. We show that localized hypothermia after NIHL preserves residual hearing and rescues noise-induced synaptopathy over a period of months. Discussion This study establishes a minimally-invasive therapeutic paradigm with a high potential for rapid translation to the clinic for long-term preservation of hearing health.
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Affiliation(s)
| | - Andrea Rivero
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL, United States
| | - Rachele Sangaletti
- The Miami Project to Cure Paralysis, University of Miami, Coral Gables, FL, United States
| | - W. Dalton Dietrich
- Department of Otolaryngology, University of Miami, Coral Gables, FL, United States
| | - Michael E. Hoffer
- The Miami Project to Cure Paralysis, University of Miami, Coral Gables, FL, United States
| | | | - Suhrud M. Rajguru
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL, United States
- The Miami Project to Cure Paralysis, University of Miami, Coral Gables, FL, United States
- RestorEar Devices LLC, Bozeman, MT, United States
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Wang G, Hurr C. Effects of cutaneous administration of an over-the-counter menthol cream during temperate-water immersion for exercise-induced hyperthermia in men. Front Physiol 2023; 14:1161240. [PMID: 37234416 PMCID: PMC10206141 DOI: 10.3389/fphys.2023.1161240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/14/2023] [Indexed: 05/28/2023] Open
Abstract
Introduction: Hyperthermia impairs various physiological functions and physical performance. We examined the effects of cutaneous administration with an over-the-counter (OTC) analgesic cream containing 20% methyl salicylate and 6% L-menthol during temperate-water immersion (TWI) for exercise-induced hyperthermia. Methods: In a randomized crossover design, twelve healthy males participated in both of two experiments. Firstly, participants underwent a 15-min TWI at 20°C with (CREAM) or without (CON) cutaneous application of an analgesic cream. Cutaneous vascular conductance (CVC) was measured using laser doppler flowmetry during TWI. In a subsequent experiment, same participants performed a 30-min strenuous interval exercise in a heated (35°C) environment to induce hyperthermia (~39°C), which was followed by 15 min of TWI. Results: Core body temperature, as measured by an ingestible telemetry sensor, and mean arterial pressure (MAP) were measured. CVC and %CVC (% baseline) were higher during TWI in CREAM than in CON (Condition effect: p = 0.0053 and p = 0.0010). An additional experiment revealed that core body heat loss during TWI was greater in CREAM than in CON (Cooling rate: CON 0.070 ± 0.020 vs. CREAM 0.084°C ± 0.026°C/min, p = 0.0039). A more attenuated MAP response was observed during TWI in CREAM than in CON (Condition effect: p = 0.0007). Conclusion: An OTC analgesic cream containing L-menthol and MS augmented cooling effects when cutaneously applied during TWI in exercise-induced hyperthermia. This was, at least in part, due to the counteractive vasodilatory effect of the analgesic cream. The cutaneous application of OTC analgesic cream may therefore provide a safe, accessible, and affordable means of enhancing the cooling effects of TWI.
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Affiliation(s)
- Gang Wang
- Integrative Exercise Physiology Laboratory, Department of Physical Education, Jeonbuk National University, Jeonju, Republic of Korea
- Department of Physical Education, Xinyang Normal University, Xingang, China
| | - Chansol Hurr
- Integrative Exercise Physiology Laboratory, Department of Physical Education, Jeonbuk National University, Jeonju, Republic of Korea
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Baker TS, Kellner CP, Colbourne F, Rincon F, Kollmar R, Badjatia N, Dangayach N, Mocco J, Selim MH, Lyden P, Polderman K, Mayer S. Consensus recommendations on therapeutic hypothermia after minimally invasive intracerebral hemorrhage evacuation from the hypothermia for intracerebral hemorrhage (HICH) working group. Front Neurol 2022; 13:859894. [PMID: 36062017 PMCID: PMC9428129 DOI: 10.3389/fneur.2022.859894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/30/2022] [Indexed: 12/03/2022] Open
Abstract
Background and purpose Therapeutic hypothermia (TH), or targeted temperature management (TTM), is a classic treatment option for reducing inflammation and potentially other destructive processes across a wide range of pathologies, and has been successfully used in numerous disease states. The ability for TH to improve neurological outcomes seems promising for inflammatory injuries but has yet to demonstrate clinical benefit in the intracerebral hemorrhage (ICH) patient population. Minimally invasive ICH evacuation also presents a promising option for ICH treatment with strong preclinical data but has yet to demonstrate functional improvement in large randomized trials. The biochemical mechanisms of action of ICH evacuation and TH appear to be synergistic, and thus combining hematoma evacuation with cooling therapy could provide synergistic benefits. The purpose of this working group was to develop consensus recommendations on optimal clinical trial design and outcomes for the use of therapeutic hypothermia in ICH in conjunction with minimally invasive ICH evacuation. Methods An international panel of experts on the intersection of critical-care TH and ICH was convened to analyze available evidence and form a consensus on critical elements of a focal cooling protocol and clinical trial design. Three focused sessions and three full-group meetings were held virtually from December 2020 to February 2021. Each meeting focused on a specific subtopic, allowing for guided, open discussion. Results These recommendations detail key elements of a clinical cooling protocol and an outline for the roll-out of clinical trials to test and validate the use of TH in conjunction with hematoma evacuation as well as late-stage protocols to improve the cooling approach. The combined use of systemic normothermia and localized moderate (33.5°C) hypothermia was identified as the most promising treatment strategy. Conclusions These recommendations provide a general outline for the use of TH after minimally invasive ICH evacuation. More research is needed to further refine the use and combination of these promising treatment paradigms for this patient population.
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Affiliation(s)
- Turner S. Baker
- Icahn School of Medicine at Mount Sinai, Sinai BioDesign, New York, NY, United States
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- *Correspondence: Turner S. Baker
| | - Christopher P. Kellner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Fred Rincon
- Department of Neurology, Thomas Jefferson University Hospital, Thomas Jefferson University, Philadelphia, PA, United States
| | - Rainer Kollmar
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
- Department of Neurology and Neurological Intensive Care, Darmstadt Academic Teaching Hospital, Darmstadt, Germany
| | - Neeraj Badjatia
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Neha Dangayach
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - J. Mocco
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Magdy H. Selim
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, United States
| | - Patrick Lyden
- Department of Physiology and Neuroscience, Keck School of Medicine, Zilkha Neurogenetic Institute, University of Southern California, CA, United States
| | - Kees Polderman
- United Memorial Medical Center, Houston, TX, United States
| | - Stephan Mayer
- Westchester Medical Center Health Network, Valhalla, NY, United States
- Department of Neurology, New York Medical College, Valhalla, NY, United States
- Department of Neurosurgery, New York Medical College, Valhalla, NY, United States
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Wang G, Zhang T, Wang A, Hurr C. Topical Analgesic Containing Methyl Salicylate and L-Menthol Accelerates Heat Loss During Skin Cooling for Exercise-Induced Hyperthermia. Front Physiol 2022; 13:945969. [PMID: 35910580 PMCID: PMC9326359 DOI: 10.3389/fphys.2022.945969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/21/2022] [Indexed: 11/29/2022] Open
Abstract
Hyperthermia impairs physical performance and, when prolonged, results in heat stroke or other illnesses. While extensive research has investigated the effectiveness of various cooling strategies, including cold water immersion and ice-suit, there has been little work focused on overcoming the cutaneous vasoconstriction response to external cold stimulation, which can reduce the effectiveness of these treatments. Over-the-counter (OTC) topical analgesics have been utilized for the treatment of muscle pain for decades; however, to date no research has examined the possibility of taking advantage of their vasodilatory functions in the context of skin cooling. We tested whether an OTC analgesic cream containing 20% methyl salicylate and 6% L-menthol, known cutaneous vasodilators, applied to the skin during skin cooling accelerates heat loss in exercise-induced hyperthermia. Firstly, we found that cutaneous application of OTC topical analgesic cream can attenuate cold-induced vasoconstriction and enhance heat loss during local skin cooling. We also revealed that core body heat loss, as measured by an ingestible telemetry sensor, could be accelerated by cutaneous application of analgesic cream during ice-suit cooling in exercise-induced hyperthermia. A blunted blood pressure response was observed during cooling with the analgesic cream application. Given the safety profile and affordability of topical cutaneous analgesics containing vasodilatory agents, our results suggest that they can be an effective and practical tool for enhancing the cooling effects of skin cooling for hyperthermia.
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Affiliation(s)
- Gang Wang
- Integrative Exercise Physiology Laboratory, Department of Physical Education, Jeonbuk National University, Jeonju, South Korea
- Department of Physical Education, Xinyang Normal University, Xingang, China
| | - Tingran Zhang
- Integrative Exercise Physiology Laboratory, Department of Physical Education, Jeonbuk National University, Jeonju, South Korea
| | - Anjie Wang
- Integrative Exercise Physiology Laboratory, Department of Physical Education, Jeonbuk National University, Jeonju, South Korea
| | - Chansol Hurr
- Integrative Exercise Physiology Laboratory, Department of Physical Education, Jeonbuk National University, Jeonju, South Korea
- *Correspondence: Chansol Hurr,
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Péus D, Sellathurai S, Newcomb N, Tschopp K, Radeloff A. The Otoprotective Effect of Ear Cryotherapy: Systematic Review and Future Perspectives. Audiol Res 2022; 12:377-387. [PMID: 35892664 PMCID: PMC9326667 DOI: 10.3390/audiolres12040038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/20/2022] [Accepted: 06/30/2022] [Indexed: 11/16/2022] Open
Abstract
This systematic review investigates ear cooling and cryotherapy in the prevention and treatment of inner ear damage and disease, within the context of animal models and clinical studies. A literature search was carried out in the databases Pubmed and Cochrane Library. Ten studies were identified concerning the otoprotective properties of cryotherapy. Nine of these were rodent in vivo studies (mice, rats, gerbils, guinea pigs). One study involved human subjects and investigated cryotherapy in idiopathic sensorineural hearing loss. The studies were heterogeneous in their goals, methods, and the models used. Disorder models included ischemia and noise damage, ototoxicity (cisplatin and aminoglycoside), and CI-electrode insertion. All ten studies demonstrated significant cryotherapeutic otoprotection for their respective endpoints. No study revealed or expressly investigated otodestructive effects. While limited in number, all of the studies within the scope of the review demonstrated some degree of cryotherapeutic, otoprotective effect. These promising results support the conducting of further work to explore and refine the clinical applicability and impact of cryotherpeutics in otolaryngology.
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Affiliation(s)
- Dominik Péus
- Department of Otorhinolaryngology, University of Oldenburg, 26122 Oldenburg, Germany; (N.N.); (A.R.)
- Department of Otorhinolaryngology, Cantonal Hospital Baselland, 4410 Liestal, Switzerland; (S.S.); (K.T.)
- Correspondence: ; Tel.: +49-441-2360
| | - Shaumiya Sellathurai
- Department of Otorhinolaryngology, Cantonal Hospital Baselland, 4410 Liestal, Switzerland; (S.S.); (K.T.)
- Department of Biomedicine, University of Basel, 4001 Basel, Switzerland
| | - Nicolas Newcomb
- Department of Otorhinolaryngology, University of Oldenburg, 26122 Oldenburg, Germany; (N.N.); (A.R.)
- The Software Revolution, Inc., Kirkland, WA 98034, USA
| | - Kurt Tschopp
- Department of Otorhinolaryngology, Cantonal Hospital Baselland, 4410 Liestal, Switzerland; (S.S.); (K.T.)
| | - Andreas Radeloff
- Department of Otorhinolaryngology, University of Oldenburg, 26122 Oldenburg, Germany; (N.N.); (A.R.)
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Hong JM, Choi ES, Park SY. Selective Brain Cooling: A New Horizon of Neuroprotection. Front Neurol 2022; 13:873165. [PMID: 35795804 PMCID: PMC9251464 DOI: 10.3389/fneur.2022.873165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022] Open
Abstract
Therapeutic hypothermia (TH), which prevents irreversible neuronal necrosis and ischemic brain damage, has been proven effective for preventing ischemia-reperfusion injury in post-cardiac arrest syndrome and neonatal encephalopathy in both animal studies and clinical trials. However, lowering the whole-body temperature below 34°C can lead to severe systemic complications such as cardiac, hematologic, immunologic, and metabolic side effects. Although the brain accounts for only 2% of the total body weight, it consumes 20% of the body's total energy at rest and requires a continuous supply of glucose and oxygen to maintain function and structural integrity. As such, theoretically, temperature-controlled selective brain cooling (SBC) may be more beneficial for brain ischemia than systemic pan-ischemia. Various SBC methods have been introduced to selectively cool the brain while minimizing systemic TH-related complications. However, technical setbacks of conventional SBCs, such as insufficient cooling power and relatively expensive coolant and/or irritating effects on skin or mucosal interfaces, limit its application to various clinical settings. This review aimed to integrate current literature on SBC modalities with promising therapeutic potential. Further, future directions were discussed by exploring studies on interesting coping skills in response to environmental or stress-induced hyperthermia among wild animals, including mammals and birds.
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Affiliation(s)
- Ji Man Hong
- Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
- Department of Biomedical Science, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
- *Correspondence: Ji Man Hong
| | - Eun Sil Choi
- Department of Biomedical Science, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
| | - So Young Park
- Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
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Masè M, Micarelli A, Falla M, Regli IB, Strapazzon G. Insight into the use of tympanic temperature during target temperature management in emergency and critical care: a scoping review. J Intensive Care 2021; 9:43. [PMID: 34118993 PMCID: PMC8199814 DOI: 10.1186/s40560-021-00558-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/30/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Target temperature management (TTM) is suggested to reduce brain damage in the presence of global or local ischemia. Prompt TTM application may help to improve outcomes, but it is often hindered by technical problems, mainly related to the portability of cooling devices and temperature monitoring systems. Tympanic temperature (TTy) measurement may represent a practical, non-invasive approach for core temperature monitoring in emergency settings, but its accuracy under different TTM protocols is poorly characterized. The present scoping review aimed to collect the available evidence about TTy monitoring in TTM to describe the technique diffusion in various TTM contexts and its accuracy in comparison with other body sites under different cooling protocols and clinical conditions. METHODS The scoping review was conducted following the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for scoping reviews (PRISMA-ScR). PubMed, Scopus, and Web of Science electronic databases were systematically searched to identify studies conducted in the last 20 years, where TTy was measured in TTM context with specific focus on pre-hospital or in-hospital emergency settings. RESULTS The systematic search identified 35 studies, 12 performing TTy measurements during TTM in healthy subjects, 17 in patients with acute cardiovascular events, and 6 in patients with acute neurological diseases. The studies showed that TTy was able to track temperature changes induced by either local or whole-body cooling approaches in both pre-hospital and in-hospital settings. Direct comparisons to other core temperature measurements from other body sites were available in 22 studies, which showed a faster and larger change of TTy upon TTM compared to other core temperature measurements. Direct brain temperature measurements were available only in 3 studies and showed a good correlation between TTy and brain temperature, although TTy displayed a tendency to overestimate cooling effects compared to brain temperature. CONCLUSIONS TTy was capable to track temperature changes under a variety of TTM protocols and clinical conditions in both pre-hospital and in-hospital settings. Due to the heterogeneity and paucity of comparative temperature data, future studies are needed to fully elucidate the advantages of TTy in emergency settings and its capability to track brain temperature.
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Affiliation(s)
- Michela Masè
- Institute of Mountain Emergency Medicine, Eurac Research, Drususallee/Viale Druso 1, I-39100, Bolzano, Italy.,IRCS-HTA, Bruno Kessler Foundation, Trento, Italy
| | - Alessandro Micarelli
- Institute of Mountain Emergency Medicine, Eurac Research, Drususallee/Viale Druso 1, I-39100, Bolzano, Italy.,ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Marika Falla
- Institute of Mountain Emergency Medicine, Eurac Research, Drususallee/Viale Druso 1, I-39100, Bolzano, Italy.,Centre for Mind/Brain Sciences, CIMeC, University of Trento, Rovereto, Italy
| | - Ivo B Regli
- Institute of Mountain Emergency Medicine, Eurac Research, Drususallee/Viale Druso 1, I-39100, Bolzano, Italy.,Department of Anesthesia and Intensive Care, "F. Tappeiner" Hospital, Merano, Italy
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Drususallee/Viale Druso 1, I-39100, Bolzano, Italy.
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Lembo M, Vedetta C, Moscato U, Del Gaudio M. Thermal discomfort in healthcare workers during the COVID-19 pandemic. LA MEDICINA DEL LAVORO 2021; 112:123-129. [PMID: 33881006 PMCID: PMC8095330 DOI: 10.23749/mdl.v112i2.10621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/20/2020] [Indexed: 02/06/2023]
Abstract
Introduction: Due to the COVID-19 pandemic, healthcare workers are now required to use additional personal protective equipment (PPEs) to protect themselves against the virus. That led to an increased clothing insulation which is negatively affecting the perceived healthcare workers’ thermal sensation. Objectives: While demonstrating through software simulations the potential level of thermal discomfort healthcare workers involved in the COVID-19 emergency can be subjected to, this work aims at identifying measures to improve thermal sensation perception and acceptable thermal conditions for medical personnel. Methods: After having obtained the insulation values of individual clothing used by staff during COVID-19 emergency through the use of a thermal well-being evaluation software, the Fanger indexes (PMV - Predicted Mean Vote and PPD - Predicted Percentage of Dissatisfied) were calculated in order to estimate staff satisfaction to microclimatic conditions. Results: The use of COVID-19 additional PPEs with an air temperature equal to 22 °C (normally considered optimal) brings the PMV index equal to 0.6, which corresponds to 11.8 % being unsatisfied (PPD) due to perceived heat. Discussion: The use of additional protective devices significantly increases the clothing insulation level, facilitating the onset of conditions of thermal discomfort in the health workers. Workers engaged in the execution of nasopharyngeal swabs were most affected by the summer weather conditions and certainly represent the most critical category, for which it would be recommended to implement a higher turnover of service to reduce individual exposure time and consequent discomfort.
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Affiliation(s)
- Marco Lembo
- Funzione Servizio Prevenzione e Protezione, Ospedale Pediatrico Bambino Gesù - IRCCS, Roma, Italia.
| | - Carmela Vedetta
- UOC di Neonatologia e Terapia Intensiva Neonatale, Azienda Ospedaliera S. Giuseppe Moscati di Avellino, Italia.
| | - Umberto Moscato
- Istituto di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Roma, Italia.
| | - Michele Del Gaudio
- INAIL Settore Certificazione, Verifica e Ricerca. UOT di Avellino, Italia.
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